Simple

Tooth
Extraction
Technique
AMIN ABUSALLAMAH

Outline
Patient and Surgeon Position
Separation of Teeth from Soft Tissues
Extraction Forceps
Surgeon Preparation
Requirements of Ideal Extraction
Mechanical Principles for Tooth Extractions
Role of operators` hand

DEFINITION

Tooth

extraction is

The painless removal of the

whole tooth, or root, with minimal
trauma to the investing tissues, so
that the wound heals uneventfully &
no post-operative prosthetic problem
is created.

INDICATIONS
OF
EXODONTIA

1.

Caries in 48.8% cases abscess

2.

Periodontal diseases in 40.7% cases to prevent alveolar ridge resorption

3.

Tooth with necrosed pulp & periapical lesion not responding to endodontic
treatment

4.

Over retained deciduous tooth but take radiograph first

5.

Orthodontic purpose

6.

Prosthetic purpose

7.

Unrestorable tooth

8.

Impacted tooth

9.

Supernumerary tooth

10.

Grossly decayed 1M / 2M make room for 3 rd molar

11.

Tooth in fracture line

12.

Teeth directly involved by cyst & tumor

13.

Teeth in the area of therapeutic irradiation

14.

Teeth acting as foci of infection

ex. bacterial endocarditis
- rheumatic fever

CONTRAINDICATIONS
of EXODONTIA

Other relative systemic contraindications

Acute blood dyscrasias

acute leukemia ,

agranulocytosis,

Untreated coagulopathies

congenital or

acquired

Adrenal insufficiencies

Within 6 months of myocardial

infarction

CONTRAINDICATIONS :
A. Absolute : Central Haemangioma. May cause
uncontrolled bleeding.
A-V malformation.
B. Relative :
When some precautions have to be taken.
1. Local

Acute cellulitis.
ANUG.

2. Systemic Uncontrolled Diabetes Mellitus,

Hypertension.
Bleeding disorders.
Cardiovascular diseases.
Liver disorders.
Patients on long-term steroid therapy.

It may be judicious to delay the extraction until certain

local or systemic condition corrected or modified.

In the era of antibiotics acute infection of odontogenic

origin are not considered as absolute contraindication of
immediate extraction.

NUG / HERPETIC GINGIVOSTOMATITIS spread of

infection & greater degree of systemic reaction.

Previously irradiated area (within 1 year) less trauma

+ pre & post-op antibiotic prophylaxis

Patient and surgeon

Position

For a maxillary extraction

the chair should be tipped
backward and maxillary
occlusal plane is at 60 degrees
to the floor. The height of the
chair should be patient's
mouth is at or below the
operator's elbow level

For the extraction of

mandibular teeth, the
patient should be positioned
in a more upright position. the
occlusal plane is parallel to
the floor. The chair should
be lower than for
extraction of maxillary

Cont

For all maxillary teeth and anterior

mandibular teeth, the dentist is to the
front and right (and to the left, for lefthanded dentists) of the patient.

For the posterior mandibular teeth

the dentist is positioned in front of or
behind and to the right (or to the left,
for left-handed dentists) of the patient

PRINCIPLES
OF
EXODONTIA

Separation of Teeth
from Soft Tissues

The

first step in removing a tooth using the

simple technique is to sever or loosen the soft
tissue attachment surrounding the tooth.

Two

instruments are required to sever the soft

tissue attachment:

(a) the straight,(b) curved desmotomes .

Cont
The

straight desmotome is
used for the 6 maxillary
anterior teeth,

while

the curved desmotome

is used for the rest of the
maxillary teeth and all the
mandibular teeth.

straight

too.

elevator can be use

THE MECHANICAL
PRINCIPLES
Expansion of bony socket

forcep extraction

sufficient tooth structure

elastic bone (children)

1.

multiple small fractures of buccal cortical bone

Use of a lever & fulcrum
remove the tooth/root along the path of least resistance
basic factor governing the use of elevators

THE MECHANICAL PRINCIPLES

2.

The insertion of wedge or wedges between

tooth-root & bony socket wall

3.

Wheel & axle principle

Forces applied during

extraction of tooth

Components of
Forceps

The basic components of the extraction forceps

are the handle, which is above the hinge, and
the beaks, which are below the hinge

Extraction Forceps

The maxillary incisor teeth are extracted with the upper

straight forceps.

Extraction Forceps
The

blades of upper premolar forceps are

mirror image of each other, and can be
used to extract both right and left
maxillary premolars.

Extraction Forceps

The buccal beak of each forceps has a pointed design,

which fits into the buccal bifurcation of the two buccal
roots.

Maxillary left molar forcepsMaxillary right molar forceps

Extraction Forceps

Bayonet extraction forceps for Elongated beak is designed

for extraction of maxillary third molars and roots.

Extraction Forceps

Lower root forceps with fine blades are used to extract

lower incisors,premolars, and roots.

Extraction Forceps
Lower

permanent molar forceps used for

extraction of mandibular permanent teeth.

Point

of the beak fits in the furcation of the

molars.

Can

be used on mandibular right or left side.

PREOPERATIVE
ASSESSMENT

Take history of

1. general disease
2. nervousness
3. resistance to inhalational anesthesia
4. previous difficulty with extraction

Oral hygiene status of the patient

oral prophylaxis
antiseptic mouth rinse

Clinical examination of the tooth

Clinical examination of the oral cavity- any prosthesis

 PREOPERATIVE

RADIOGRAPHS
mandatory for all extractions.

CHOICE OF ANESTHESIA
General factors
GENERAL ANESTHESIA

LOCAL ANESTHESIA

5-10 min.

30-45 min.

uncooperative patients

No pre-op preparation

Respiratory tract disease

Cardiovascular diseases

Local factors
Acute infection at the site of injection
Hemangioma

Operator Preparation
Operator

must
prevent
inadvertent
injury
or
transmission of infection to
their patients or to themselves.

To

prevent this transmission,

surgical gloves, surgical mask,
and eyewear with side shields
are required.

Cont..
For

patient:

1.

A sterile disposable towel

drape should be put
across the patient's chest .

2.

proper oral hygiene is

very
important
before
extraction.

Expansion of the bony

socket

Expansion of the bony socket

by use of the wedge-shaped
beaks of the forceps .

The

forceps
should
be
seated with strong apical
pressure to expand crestal
bones and to displace center
of rotation as apically as
possible .

Cont
If

center of rotation is not far

enough apicaliy, it is too far
occlusally, which results in
excess movement of tooth
apex.

Excess

motion of root apex

caused by high center of
rotation results in fracture of
root apex.

Cont
Buccal

or labial pressure
applied to tooth will expand
the
buccal
cortical
plate
toward the crestal bone with
some lingual expansion at
apical end of the root.
Lingual or palatal pressure will
expand lingual cortical plate at
crestal
area
and
slightly
expand buccal bone at apical
area.

Cont

The initial linguo-buccal movement for extraction of lower

second mandibular molar.

Initial rotational forces It

is useful for removal of
teeth with conical roots;
such
as
maxillary
central.

Cont
Tractional

forces are useful for final

removal of tooth from socket. They
should always be small forces,
because teeth are not "pulled."

The Final withdrawal movement for Most of

the upper and lower teeth is an outwardocclusal direction. Except the lower third
molar which should be in a lingual- occlusal
way and maxillary 3rd molar should be distobuccal.

The proper use of forceps

in luxation and removal of
teeth
1. The extraction movements are essentially
three movements
which are outward,
inward, and rotatory movements.
2.

The movement should be steady and with

a reasonable force.

Cont
3. Outward (buccal or labial) movement is the
initial movement of all teeth except the lower
second and third molar where the buccal plate
of bone reinforced by the external oblique ridge.
4. Inward (lingual or palatal) movement is the
initial movement during the extraction of the
lower
second
and third molars.

Cont
5. Primary Rotatory movement is the initial
movement used in upper central incisor and
lower second premolar.
6. If a resistance is felt in primary rotation, a
bucco-lingual movement should be started.
7. If rotatory movement continued, a spiral
fractured of the tooth root may occur.

Cont
7. The force should be held for several seconds
to allow the bone time to expand.
8. Once the alveolar bone has expanded
sufficiently and the tooth has been luxated, a
slight traction force, usually directed
buccally, can be used.
9. Final movement is the movement by which
the tooth is removed from its bony socket. It
should be always directed outward and
occlusally to avoid traumatizing the opposing
tooth,

Cont
10. The extraction forceps
blade should be applied
to the carious side first,
and the first movement
made toward the caries.

Role of operators`
hand

The opposite hand plays an important role in

supporting and stabilizing the lower jaw
when mandibular teeth are being extracted.

The

opposite hand supports the alveolar

process and provides tactile information to
the operator concerning the expansion of the
alveolar process during the luxation period.

Cont

References

Peterson, L. J. Contemporary Oral and Maxillofacial

Surgery, 4th ed. Amsterdam Elsevier Science. 2002.
ch.7

Sweedan, O. A. Textbook of Oral and Maxillofacial v,

1st ed., 2009.

Fragiskos D. Fragiskos Oral Surger. 2007

Carmen Scheller BASIC GUIDE TO DENTAL

INSTRUMENTS